Madness is a complex and contested term. Through time and across cultures it has acquired many formulations: for some, madness is synonymous with unreason and violence, for others with creativity and subversion, elsewhere it is associated with spirits and spirituality. Among the different formulations, there is one in particular that has taken hold so deeply and systematically that it has become the default view in many communities around the world: the idea that madness is a disorder of the mind. -/- (...) Contemporary developments in mental health activism pose a radical challenge to psychiatric and societal understandings of madness. Mad Pride and mad-positive activism reject the language of mental 'illness' and 'disorder', reclaim the term 'mad', and reverse its negative connotations. Activists seek cultural change in the way madness is viewed, and demand recognition of madness as grounds for identity. But can madness constitute such grounds? Is it possible to reconcile delusions, passivity phenomena, and the discontinuity of self often seen in mental health conditions with the requirements for identity formation presupposed by the theory of recognition? How should society respond? -/- Guided by these questions, this book is the first comprehensive philosophical examination of the claims and demands of Mad activism. Locating itself in the philosophy of psychiatry, Mad studies, and activist literatures, the book develops a rich theoretical framework for understanding, justifying, and responding to Mad activism's demand for recognition. (shrink)

At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently (...) disabling: the first arises from the normative nature of disability judgements, and the second from the implications of political activism in terms of being a social subject. In the process of arguing for these two bulwarks, the paper explores the basic structure of the social model of disability in the context of debates on naturalism and normativism; the applicability of the social model to madness; and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter. (shrink)

The enlarging domain of psychiatric intervention is frequently associated with the undue medicalization of unusual experiences. In such a climate, it becomes of utmost importance to carefully choose appropriate candidates for the psychiatric gaze. This suggests a need to draw a distinction between religious experiences (with psychotic form) and pathological psychotic experiences. As Jackson and Fulford (1997) maintain, “spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine. It (...) would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political .. (shrink)

Central to the identity of modern medical specialities, including psychiatry, is the notion of hypostatic abstraction: doctors treat conditions or disorders, which are conceived of as “things” that people “have.” Mad activism rejects this notion and hence challenges psychiatry’s identity as a medical specialty. This article elaborates the challenge of Mad activism and develops the hypostatic abstraction as applied to medicine. For psychiatry to maintain its identity as a medical speciality while accommodating the challenge of Mad activism, it must develop (...) an additional conception of the clinical encounter. Toward elaborating this conception, this article raises two basic framing questions: For what kind of understanding of the situation should the clinical encounter aim? What is the therapeutic aim of the encounter as a whole? It proposes that the concepts of “secondary insight” (as the aim of understanding) and of “identity-making” (as a therapeutic aim) can allow the clinical encounter to proceed in a way that accommodates the challenge of Mad activism. (shrink)

The centenary of Karl Jaspers' General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work. Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers (...) a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: Is second-order empathy possible? Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Theme Religious Experience and PsychopathologyMohammed Abouelleil Rashed, MD, PhDIn the first verse of the seventeenth sura of the Qur’an, Al-Isra’,1 we learn about Prophet Mohammed’s night-time journey to Al-Quds (Jerusalem):Glory to Him who made His servant travel by night from the sacred place of worship [in Mecca] to the furthest place of worship [in Al-Quds], whose surroundings We have blessed, to show him some of (...) Our signs.The year was 621 AD. The Prophet was transported by a fabled creature known as Al-Buraq—a name that derives from the Arabic word for lightning—that was able to cover the distance of a month-long journey in a matter of hours. Accompanied by the Angel Jibreel, the second part of the journey, Al-Mi’raj,2 involved an ascension to the Heavens. Along the way, the Prophet met several past Messengers until, now all alone, he received communications from Allah and, according to some accounts, encountered the Divine manifestation.When he returned to Mecca the following morning and recounted his miraculous journey, he met with a familiar range of responses. Abu Bakr Al-Siddiq, who was to become the first Caliph following the Prophet’s death, immediately believed him and never doubted the veracity of his account. Members of the Quraish tribe, a polytheistic tribe then dominant in the Arabian Peninsula and hostile to the Prophet, denounced his account outright, mocking him for its apparent impossibility or accusing him of madness. Others agreed that the Prophet had undergone the experiences he described but reasoned that this was a spiritual journey and not a physical one of literal bodily transportation. Later Christian critics went further by reducing the experience to the manifestations of epilepsy and insanity, or by questioning its Divine origin and attributing it to spirits and satanic entities.It really did matter how the Prophet’s experiences were understood and received: the stakes could not be higher. Here was the Prophet in the 11th year of a mission that called for a renewal of the message of monotheism. If true, this journey to the three holy sites of Islam (Mecca, Medina, Al-Quds) and to the Heavens was further evidence of his Prophethood and one of his miracles. His [End Page 195] critics and his followers had their own answer to the question on everyone’s mind: did the Prophet really undergo these experiences, whether in a spiritual or physical sense, or was it an expression of a pathological disturbance?________The year is 1997 AD. Mike Jackson and Bill Fulford publish a paper entitled Spiritual Experience & Psychopathology. The paper engages the exact question that troubled the Prophet’s critics and allies 1,376 years earlier. The question is now framed as a distinction between spiritual and pathological varieties of psychotic phenomena. And even though the stakes do not rise to the level of Prophethood—we have banished Prophets a long time ago—they are high enough:Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine.... It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill.(Jackson & Fulford, 1997, p. 42)Jackson and Fulford were not the first to invoke the distinction as a problem to be examined. In modern times, this is usually traced to William James’ Varieties of Religious Experience (1902), where he drew attention to the overlap between religious experiences and psychosis. James, like Jackon and Fulford a century later, noted the phenomenological similarities among these two ‘types’ of experience: voices, visions, an ineffable sense of significance to otherwise mundane events, and the loss of agency to external forces and powers.The 1997 paper stimulated much debate, responses, and rebuttals. In the process, at least four approaches for drawing the distinction have emerged: by appealing to the outcome of the experience; by appealing to theological criteria; by examining the organization of the experience; and by paying attention to the process of meaning-making in its cultural context. On the... (shrink)

Debates on the distinction between religious experience and mental disorder tend to assume, rather than argue for, the existence of unique types of experience: the religious and the psychopathological. This paper interrogates this approach to the problem. It deconstructs the distinction by examining what the distinction is about beyond the terms in which it is presented and whether it matters who is trying to make it. A key idea is that one’s standpoint in the debate—that is, whether one adopts a (...) religious or a secular standpoint—determines what they can say about the distinction. This leads to the central argument of the first part of the paper: The distinction between religious experience and mental disorder can only be invoked from a secular standpoint but can only be clarified from a religious standpoint. In other words, if you have the grounds to invoke it, you cannot have the tools to clarify it; and if you have the tools to clarify it, you do not have the grounds to invoke it. In the second part, the paper follows through the implications, from a secular standpoint, of accepting this argument. It appeals to the politics of difference and to mental health activism to argue against the binary view whereby mental distress is either illness and incapacity or a path to purpose and identity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Are Mental Health "Peer Support Workers" Experts by Experience?The author reports no conflict of interests.In this well-argued paper, Dr. Abdi Sanati asks whether a person's experience of mental illness could be the basis for professional expertise and concludes that, "on its own," it cannot be. Elsewhere he states that "the different forms of knowledge that are required for expertise … could not be produced solely on the basis of (...) personal experience" (Sanati, 2024, 107). The qualifications "on its own" and "solely" suggest that personal experience of mental illness could be the basis for professional expertise if other conditions are also met. What are these conditions, and can they be met? Gratefully, Sanati provides an excellent exposition of a concept of expertise and the conditions that are required for satisfying it.Expertise needs to be thought of as a "form of life" that requires more than the accumulation of knowledge and cannot happen in isolation. To become an expert, you need to be part of a community through which you can acquire factual knowledge (knowledge-that) and acquire the practical capacities and dispositions (knowledge-how) that enable you to conduct actions related to your area of expertise. With training over time, experts develop tacit knowledge that enables them to "ap ply background theories to new cases," which is why an expert is able to deal with a multitude of cases that appear different from each other. Experts should be able to hold a relatively cohesive view of their subject matter and see how it all 'holds together'.The importance of community for the possibility of becoming an expert is further emphasized by Sanati's appeal to Wittgenstein's Private-Language Argument. A 'private language,' if such a thing were to exist, is a language that enables the person to express mental states with reference only to what is occurring in the speaker's mind and known through introspection. This language, in being private, makes sense only to the speaker and is not comprehensible to others. Introspection allows privileged access to my mental states, which thus become a unique source of knowledge available only to me. And the argument against such a private language is that it is impossible, for in being unintelligible to others, it becomes nonsensical as such. The reasons behind this have to do with the nature of language as a rule-based activity that requires intersubjective agreement, engaging in which is to partake in a form-of-life. [End Page 113]Putting aside the details of the Private-Language Argument, I am interested in the conclusion that Sanati draws from it. He starts by pointing out that what is taken as the basis for expertise-by-experience is the supposed privileged access to one's mental states that leads to a unique form of knowledge. It is this knowledge that underlies the claim to expertise. Sanati's view is that one cannot acquire a kind of knowledge completely inaccessible to others yet expressed in language as this would amount to use of a private language, which is impossible. And so, the person is either expressing nonsense or is merely using shared language. If the latter, then the alleged uniqueness of the experience is lost as it has been brought under a rule-based form of life.Sanati seems to imply that experience can only constitute a unique form of knowledge if it arises from a single mind through introspection and use of a private language. Given that this is not possible, the experience can no longer be unique. But I do not see why it cannot be a form of knowledge which, while not being unique to a single individual, is still an expression of human experience that only a proportion of the population go through, the proportion who are diagnosed with a certain mental health condition. In other words, a form of knowledge does not to have to be unique to be distinct, and if it is distinct then perhaps it can constitute the basis for expertise if other conditions are also met. In fact, this is suggested by Sanati's conclusion when he writes: "for the community of experts to exist there... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Can (and Cannot) Be Said About the Distinction Between Religious Experience and PsychopathologyMohammed Abouelleil Rashed, MD, PhDThe distinction between religious experience and psychopathology as a puzzle to be pondered, debated, clarified, and analyzed is an example of a thoroughly modern problem. It is modern in that the distinction can only make sense if our starting assumption is the existence of unique and separate types of experience that might (...) overlap phenomenologically but are ultimately different entities that should be distinguished from each other. And it can only have this sort of sense in a secular worldview where the possibility of a fully areligious type of psychological suffering is on the table and widely accepted. By framing the matter in this way, the debate presupposes, rather than argues for, the existence of unique and separate types of experience. This is a major presupposition, and its coherence cannot be assumed, nor can we ignore the impact of our standpoint in the debate on whether or not we can actually make that distinction let alone resolve it. In the original paper (Rashed, 2024), I deconstruct the distinction by examining what can, and cannot, be said about it given the standpoint that we adopt. In what follows, I respond to Awais Aftab’s and Warren Kinghorn’s thoughtful commentaries on my paper and in the process clarify my thesis further.What We Believe and the limits of What We Can ArgueAwais Aftab (2024) perceptively points out that the way I define the terms renders the distinction between religious experience and psychopathology an instance of the broader distinction between the religious worldview and the scientific worldview. Accordingly, my approach deviates from the usual [End Page 219] approach in these debates, which tend to focus on specific areas of phenomenology (delusion, hallucinations, low mood, etc.). This focus then directs the debate toward distinguishing these states from each other, and not toward asking if there is a distinction that needs to made at all, and, if there is, what the distinction is really about. In order to overcome this potential blind spot, we need to step back and examine our assumptions about the possibility and the nature of the allegedly competing conceptions of religious experience and psychopathology. And to do so, we need to apprehend the distinction in the broadest possible sense, as it is there that we can identify our assumptions about those ‘things’ we are trying to distinguish from each other.The first step in deconstructing this debate is to identify our stance towards the categories of religious experience and mental disorder, and what this stance enables us to say and prohibits us from saying. On an ontological stance, we would be dealing with two distinct categories of experience out there in the world for us to identify, study, and differentiate; there is a truth of the matter as to the origin of the experience, a truth that we can get hold of if we can get to the essence of the respective phenomena. On a constructivist stance, there is no sense to this claim, and what we have are two possible interpretations of experience that cannot be differentiated from each other from a natural or a supernatural standpoint; they do not reflect distinct types of experience, merely the attribution of meaning, which can always go the other way depending on the social situation and the cultural context. And so, our initial stance as to an ontological or constructivist understanding will constrain from the outset what can and cannot be said about the distinction between religious experience and psychopathology. The issue is further complicated by the fact that we can hold a range of positions: we can, at the same time, adopt an ontological view of religious experience and a constructivist view of mental disorder, or vice versa, and in each case we might end up in a different place.For philosophers, theologians, and others writing from a religious standpoint, we can assume that they are adopting an ontological reading of religious experience. In other words, they take it to be true that some experiences have a divine origin, connect the person to non... (shrink)

Proposing narratives that reflect our values and address what we believe to be, and what in fact in this case are, valid concerns is no doubt an attractive venture. But good intentions are not enough, and often it is careful analysis that shows why this is the case. Alastair Morgan's (2023) essay Power, Threat, Meaning Framework: A Philosophical Critique is a bright example of philosophy-in-action; it demonstrates, to use a popular expression, that the road to hell is paved with good (...) intentions. In this commentary I argue that while the concerns of the authors of the Power Threat Meaning Framework (PTMF) are valid, their proposed solutions lead us to yet another master narrative.The PTMF presents itself as an... Read More. (shrink)

Among the different approaches in mental health activism, there is an ongoing concern with the concepts and meanings that should be brought to bear upon mental health phenomena. Aspects of Mad Pride activism resist the medicalisation of madness, and seek to introduce new, non-pathologizing narratives of psychological, emotional, and experiential states. This essay proposes a view of Mad Pride activism as engaged in no less than the creation of a new culture of madness. The revisioning and revaluing of madness requires (...) transformations in the basic concepts constitutive of current mental health narratives. This process is illustrated with the concept of self and its relation to passivity phenomena (thought insertion). The essay concludes with some of the challenges facing Mad Pride's ambition to enrich the cultural repertoire. (shrink)

Cultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture (...) as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct. (shrink)

The challenge of understanding psychotic phenomena is one of the enduring problems in the philosophy of psychiatry. The first to formulate the problem in its philosophical dimension was Karl Jaspers in General Psycho-pathology. Jasper’s solution was rather pessimistic, for he argued that we cannot extend empathic understanding to certain phenomena, such as primary delusions. His work was followed by a long period of philosophical silence on the issue, and it was only three decades ago that philosophy began to engage once (...) again with the problem of understanding. Today there is a rich literature that explores this problem: from philosophy of language to European phenomenology, and from theories... (shrink)

Political activity on the basis of a shared identity has been with us for several decades. Race, sexual orientation, gender, and myriad other categories form the center-of-gravity around which social groups demand recognition of the validity and value of their self-understandings. How should social and political institutions respond to these demands? In contemporary social and political philosophy much of the weight of answering this question has fallen on developing a theory of recognition. That theory would then perform several functions: It (...) could provide an explanation as to the emergence and subsequent contestation of shared social norms; it could offer an account of the motivation that drives people to... (shrink)